Maintenance of Lost Weight and Long-Term Management of Obesity

Abstract

Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.

Keywords: Appetite; Behavioral counseling; Obesity treatment; Physiology; Weight loss; Weight maintenance.

Figure 1

Average time course of weight regain after a weight loss intervention. Data from Anderson JW, Konz EC, Frederich RC, et al. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001;74(5):579–584.

Figure 2

Mathematical model simulations of body weight, fat mass, energy intake, energy expenditure, appetite, and effort for two hypothetical women participating in a weight loss program. The curves in blue depict the typical weight loss, plateau and regain trajectory whereas the orange curves show successful weight loss maintenance.

Figure 3

Weight management programs with a focus on maintenance of lost weight demonstrate improved long-term weight loss (red curve) compared to programs without maintenance visits (blue curve). Adapted from Perri MG, McAllister DA, Gange JJ, et al. Effects of four maintenance programs on the long-term management of obesity. J Consult Clin Psychol 1988;56(4):529–534; with permission.